Is it because of cutbacks, or responding to party politics? Or is it just bad journalism? A. Balharry on the story behind the story of BBC Scotland and NHS Grampian.

On Wednesday, 16th January, morning I switched on the radio shortly after 6 and heard this in the Good Morning Scotland headlines …

BBC Scotland has found that 1000’s of patients in the North East are not being treated within the Scottish Government’s 18 week guarantee because they are waiting for diagnostic tests. As many as 3500 people at risk of bone fractures are waiting 8 months for a scan to detect osteoporosis at a clinic in Aberdeen – the Scottish Government said the situation was unacceptable and it would be raising the matter with health bosses as a matter of urgency.

Certainly dramatic stuff, though as is so often the case these days with the BBC in Scotland, all was not quite what it seemed – as anyone following events will realise, culminating in its top billing in yesterday’s FMQ’s.

As I listened and watched, throughout the day, it was pretty clear the story just didn’t hang together.

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At 0735 on GMS Hayley Miller did a live two way (as it’s known) with, the author of the ‘exclusive’, Eleanor Bradford.

The main points that arose were as follows:

In a long preamble before getting to the ‘exclusive’ we heard about the ‘fiddling at NHS Lothian’ which resulted in the country wide audits, the problems at NHS Tayside, where patients were being marked down as unavailable when they were available and the weekend newspaper claims against Forth Valley, those subsequently denied.

So onto the heart of the matter, the facts according to Eleanor Bradford were:

People in NHS Grampian are having to wait 8 months for an appointment for a bone density scan because 1 of 2 scanners is broken. NHS Grampian say the 8 month wait is okay because scans don’t count. EB assured us these scans do count, then a series of statistics referring to the high percentage of people in the area marked down as unavailable which muddied the waters even further.

Then she said:

There’s been long standing scepticism, especially actually amongst the public over these waiting time targets and guarantees we keep hearing about – they always tend to think these targets don’t apply to them and I’m always coming on air saying they do apply to you – if you’re not getting treated within the government times question it – in actual fact the public seem to have been proven right – health boards have so many loopholes and get out clauses, though this wasn’t actually a get out clause, that for many people they do feel that the government may tell them they’re being treated quicker than ever but when they come to actually have treatment it doesn’t happen.

Then we were told the Scottish Government had reacted with ‘fury’, that they’d be taking it up as a matter of urgency, that NHS Grampian were looking at using mobile scanners.

The final pay off was:

NHS Grampian say their performance against national waiting time standards remains good and is currently sitting at 90%.

As a listener by now I really had no clue what the story was. Then around 815am an interview with Labour’s Jackie Baillie, this the opening question and answer:

Hayley Miller – What do you make of this situation at Grampian?

Jackie Baillie: “Well this is extraordinary, the fact that 3500 people are having their waiting time guarantee breached – weeks after NHS Grampian were given a clean bill of health by an internal audit and by the Scottish Government, and you know while these things should be monitored centrally by the Scottish Government it’s taken the BBC to break the story and surely the government should have known, surely this incorrect interpretation of these guidelines, it may well be a genuine misunderstanding but frankly it doesn’t help the people affected and it calls into question whether you can trust the SNP or NHS Grampian on waiting times.”

We were informed neither NHS Grampian or Scottish Government was available. By the lunchtime news the 3500 had become hundreds, what was going on?

At this stage I want to make clear I’m well aware the waiting list rules are complicated but I would expect a Health Correspondent to inform listeners not confuse. Since their introduction waiting time targets have always had exceptions, that of course does not suit sound bite politics, whoever is in power.

The response from NHS Grampian

So what did the subject of the story have to say? It turns out the initial BBC contact was made in the run up to Christmas. The spokesperson conceded to me that they, NHS Grampian, could have collated the accurate figures more swiftly, thus avoiding the 3500 headline – that overall waiting times for this scan are longer than they’d like BUT crucially the 18 week waiting time guarantee does not apply to all referrals. Some non urgent referrals may wait up to 8 months.

Yesterday they issued a detailed press release stating the following;

The scanner in question – remember we were told by the BBC it IS broken – was out of action Sept 2012 due to flooding but had been replaced in Nov 2012.

That the 18 week waiting time refers to 9 out of 10 of Referral To Treatment appointments, RTT’s for short – put simply those referred to a consultant. (See below)

There are currently 1900 patients on the waiting list for a scan. 550 of those on the list have been waiting more than 18 weeks BUT the vast majority of the 550 are GP referrals for a scan, discharged back to their GP, so 95% of these referrals are not covered by the 18 week RTT standard.

That they have never been confused about who is or who is not covered by the 18 weeks RTT standard.

There are no ‘hidden’ waiting lists and they are not being ‘fiddled’.

In total they have 3 scanners, 2 in Aberdeen and 1 in Elgin.

According to the official Government waiting time guidelines under the section exclusions to the 18 week rule;

Direct access referrals to Diagnostic Services where the referral is not part of a ‘Straight to Test’ referral pathway as there is no transfer of clinical responsibility to the Consultant-Led team

In addition to the NHS Grampian press release they also sent me the info sent to the BBC correspondent before Wednesday’s broadcast and later the same day.

It reveals that before the broadcast it was clear it was ‘some non urgent cases’ who were waiting up to 8 months, that the broken scanner was now operational, that 3500 was the total annual figure of all referrals, that they were waiting for up to date figures for the total number on the current waiting list.

And as to why they didn’t turn up on air on Wednesday, without accurate figures they turned it down.

As is common we’re now getting closer to the facts of the story in the days after.

It was an exclusive story based on one unnamed source so why not wait?

In Thursday’s, 17th, Reporting Scotland, an update from E Bradford –

(In reference to the initial story) it’s now ‘hundreds’ not ‘thousands’. That the current referral system is a loophole – that the patient who first spoke to her has been told she has to be referred by a consultant not a GP to qualify for the 18 weeks guarantee, that her case is urgent.

Well I understand it differently. A GP can refer you directly to a consultant (who then recommends treatment/tests) which gets you into the 18 week system, and urgent cases are seen within 2-6 weeks according to NHS Grampian.

As for ‘loophole’, well if anyone cares to read the guidelines, it is there in black and white. It’s hardly secret.

If, as I did, you put ‘NHS Grampian bone density test’ into the search engine of your choice you’ll find the relevant page, last updated October 2011, which could not be clearer, that routine waiting time is declared as ‘within 8 months’. I think we can assume this has been the case for a fair while, years maybe.

Hardly ideal, maybe NHS Grampian needs to get more scanners, maybe the patient in question is being given inaccurate information by her/his GP, maybe people are confused when they hear talk of 18 and 12 week lists given there are a number of exceptions and, as I’ve said soundbite politics don’t help. Nobody comes out of this well.

But shouldn’t the BBC do better?